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Rangell says that "structural change" is often used as a symbol for the change brought about by analysis without a clear understanding of or agreement on what "structures" are. He proposes Rapaport and Gill's formulation that "structures are configurations of a slow rate of change." A concept of change based on this understanding of structure must include a structural theory of neurosogenesis, comprising the dynamic, genetic, economic, topographic, and adaptive points of view of psychoanalytic metapsychology. He then delineates in some detail what he considers to be structural changes that occur during psychoanalysis, adding that he feels this process is more unconscious than conscious. These alterations in the id, ego, and superego are familiar to most analysts. Rangell draws our attention to what he feels is the neglected area of superego analysis. He next turns to the how of change, giving us his "own succinct working credo distilled from over four decades of clinical immersion." He focuses on two elements: the interpretation of the material that emerges from the patient's unconscious filtered through the analyst's "analyzing instrument," and the unique human relationship fostered by the analyst's maintenance of the analytic attitude. Although he gives more weight to interpretation as the causal agent, he underlines the necessity of a flexible human analytic attitude. He now sees clear evidence of structural changes in patients seen in dynamic psychotherapy and not just those in psychoanalysis, and he gives some examples from his own practice.